Within the integrated care system, Integrated Care Boards (ICBs) are responsible for NHS budgets at a local level, arranging and commissioning the provision of health and social care services in their local area.
This is a massive change in procurement regulations and means that any procurement process for health care services that started after this date must be done in compliance with the new PSR regulations.
Effectively, the new PSR regulations give the NHS and associated authorities more freedom to commission frameworks in the way they want to.
The PSR regulations will also empower ICBs to ‘direct award’ contracts by carrying out their own assessments. They can also choose to reappoint existing providers and suppliers without them having to go through a formal tender process again. So, it is always worth seeing if you can leverage the new PSR regulations to your advantage if you are a long-standing provider.
PSR selection processes
The PSR has introduced three provider selection processes that relevant authorities can follow to award contracts for health care services:
Direct award processes (A, B, and C). These involve awarding contracts to providers when there is limited or no reason to seek to change from the existing provider; or to assess providers against one another, because: – the existing provider is the only provider that can deliver the health care services (direct award process A) – patients have a choice of providers and the number of providers is not restricted by the relevant authority (direct award process B) – the existing provider is satisfying its existing contract, will likely satisfy the new contract to a sufficient standard, and the proposed contracting arrangements are not changing considerably (direct award process C).
Most suitable provider process. This involves awarding a contract to providers without running a competitive process, because the relevant authority can identify the most suitable provider.
Competitive process. This involves running a competitive process to award a contract.
Relevant authorities need to comply with defined processes in each case to evidence their decision-making, including record keeping and the publication of transparency notices.
We are advising our clients to speak to commissioners of any tenders they are looking to bid for, to see if there is any scope to direct award contracts to them under Direct Award Process C. Although, it is worth noting that these rules are new for everyone and commissioners are still learning what they can and can’t do to comply with the PSR regulations and how to assess potential providers.
For more information on bidding for health and social care contracts with the NHS and this may have changed due to the PSR regulations, contact us to see how we can help.
For some time now, the Government has been promoting its policy of ‘person-centred care’. In fact, the term was first introduced in the NHS Plan and other government policy documents in 2000.
What is person-centred care?
According to the Care Quality Commission (CQC), person-centred care is defined as ‘providers making every reasonable effort to provide opportunities to involve people in making decisions about their care and treatment and supporting them to do this’.
Since then, we have seen governments come and go with not much progress being made to ensure patients are at the heart of their own health and social care plans and treatment.
What are the latest developments in person-centred care?
Patient surveys have shown that there are still large gaps between the ambition of a person-centred health service and the reality or patient perception of their experiences.
In December, a report was published by the House of Lords entitled Patients At The Centre: Integrating Primary and Community Care. The purpose of the report was to look at the quality and accessibility of healthcare services and how primary and community care can work in a more integrated way to benefit patients and achieve that elusive ambition of ‘person-centred care’.
The report highlighted a number of major concerns with how the NHS is run, stating that ‘The NHS has failed to improve its organisational structure, funding mechanisms, infrastructure, and workforce to meet this challenge (of an aging population with multiple health conditions). As a result, it is ill-equipped to meet current healthcare demands, and its long-term sustainability is threatened.’
It went on to say that:
‘Patients are constantly being inconvenienced, endangered, or miss improved long-term health because they are not receiving joined-up care, in the right place, at the right time. Integration can help improve patient experience and offers a viable solution to many of the challenges facing the health service.’
The report suggests that the four main obstacles to achieving person-centred care through integration are:
Structures and organisations
Contracts
Data sharing
Workforce
Earlier this month, the Government published a response to this report, which has been widely criticised by those working in primary care.
What does all this mean?
Essentially the Government believes that Integrated Care Systems (ICSs) and Integrated Care Partnerships (ICPs) need time to ‘mature’ before their impact can be properly assessed. A study that will explore the impact of these system changes, formalised in the Health and Care Act 2022, has been described as ‘a multi-year project’ that will take ‘approximately three years to complete’.
For more information on how you can tender for health and social care contracts with the NHS, contact us on 0330 1331 041 or info@klowconsulting.com.
If you are a surgery or general practice looking to win substantial contracts or funding, it can be a daunting prospect, particularly if you are an already over-worked GP or Practice Manager struggling for time.
What types of GP contracts can you bid for?
APMS (Alternative Provider Medical Services) contracts are regularly put out to tender by the NHS commissioners – usually Integrated Care Boards or local authorities – every week on the Government’s Find a Tender website. This type of contact enables private sector companies to provide primary care services. They can also be used as a vehicle to commission contracts for services that are outside the scope of core general practice such as helping individuals or groups not signed up to surgeries, for example asylum seekers or the homeless.
PMS (Personal Medical Services) contracts were hugely popular and generally facilitated by NHS England and Clinical Commissioning Groups but these are being phased out in favour of a new Integrated Care Provider (ICP) contract to allow for a better integration of services.
GMS (General Medical Services) contracts are the national standard GP contract.
We tend to work more on bids for APMS contracts and, in partnership with PMA, are here to support and guide GPs and Practice Managers through the tender bid process.
In fact, we have bid on more than 300 health and social care contracts with a win rate of 93%, securing £1 billion in contracts and funding for our clients.
Is there any general practice funding available in the UK?
The latest NHS England waiting list figures, up to November 2023, stand at 7.6 million. That’s 7.6 million people who are all waiting to start elective/non urgent treatments in England.
While this has dropped ever so slightly from 7.7 million in October 2023, it is still much larger than the 7.2 million it was just a year ago in November 2022.
According to The Lancet, NHS England’s recovery plan aims to increase capacity by up to 30%, compared with pre-pandemic levels, over the next three years through a range of measures, including extra staff and increased use of the independent sector.
Due to this significant, unprecedented pressure on our healthcare system, we anticipate that there will be additional funding opportunities for GP Practices and Primary Care Networks (PCNs) made available by NHS England.
The General Practice Improvement Programme (GPIP), for example, provides nationally funded support for practices and primary care networks (PCNs) to implement modern general practice.
There is also funding available to GP practices to help them with going digital, such as cloud-based telephone systems, online consultation software and new appointment booking systems.
If you need help with winning GP contracts or funding, get in touch with K Low Consulting today to see how we can assist you. Contact info@klowconsulting.com or give us a call on 0330 133 1041.
Earlier this year, the Care Quality Commission (CQC) announced it would be making changes to the way it works with suppliers and providers. These changes would include the establishment of a new assessment framework and provider portal and will apply to providers, local authorities and integrated care systems.
Over the course of 2023, these plans progressed and the new portal started being rolled out in September with providers being invited to join in phases.
The new framework will start being used in November, again being rolled out in phases. These phases will be in geographic regions, starting with providers in the South of England, with a view to the framework working as standard from April 2024 for all providers.
The framework will retain the five key questions, but six new evidence categories will be introduced. There will also be quality statements which will focus on specific topic areas, based on people’s experiences and the standards of care they expect. These will replace the key lines of enquiry (KLOEs), prompts and ratings characteristics.
What do you need to do if you are a CQC provider?
The CQC will contact you when it is time for you to join the portal, so our advice would be to make sure they hold up to date contact details for you so you receive your portal invite and login details. You can also subscribe to receive email updates so you are kept informed of any changes as and when they are rolled out.
Also, you will be required to submit a lot more evidence, so start gathering this now.
Implications and considerations
Here at K Low Consulting, we are in a unique position. We are not a supplier or service provider to the CQC but many of our clients are. We are trusted by providers and can speak for them.
Having attended the Care Show 11 – 12 October in Birmingham and hearing a briefing from James Bullion, Chief Inspector of Adult Social Care and Integrated Care at the Care Quality Commission, we feel that these changes to the CQC Framework have big implications and we have some very real concerns that need serious consideration.
Firstly, this new framework is evidence-based, with the onus on the provider to gather and provide evidence themselves.
Since Covid, the CQC has had to carry out more desk-based audits and, if any problems were identified, a follow up inspection would take place. Even then, the CQC has struggled to meet demand and keep up with the number of in-person inspections required. So, it was obvious that any new process would need to be more efficient for the CQC.
But, with providers submitting their own evidence and quality statements, face-to-face inspections will be a thing of the past completely. Essentially, providers and suppliers can tell the CQC what they like and won’t be interviewed or tested on aspects such as safeguarding, which could adversely affect patient safety.
Another concern is that the framework is effectively becoming a self assessment process, with no independent audits or inspections taking place.
Lastly, National Institute for Health and Care Excellence (NICE) guidance and the NHS Long Term Plan identify patient-centred care as being central to good quality health services and recommend giving patients greater control over their own health and ensuring they have more personalised care when they need it. There has also been much made of the importance of the ‘patient voice’, encouraging patients to have their say on the health services they use. As part of the new framework, case studies and service user testimonials can be submitted but, as the provider is responsible for collating and uploading these, will they be truly representative? Should patients and service users be interviewed by someone independent?
It will be interesting to see how the new portal and framework pans out and we will look to do a follow up blog in due course.
Further information and guides for providers can be found on the CQC website.
FOR many industries, the pandemic has had a lasting impact, fuelling many new opportunities for growth and change, particularly in healthcare where virtual wards are now commonly used.
It’s a process which largely began during the early days of lockdown, when businesses had to react quickly to find new ways of working remotely, embracing technology to ensure they stayed connected to their staff, clients – and even their patients.
Now, as we begin to emerge from the pandemic, some of these processes have remained in place, bringing with them enormous benefits – and exciting new opportunities – for healthcare providers and their patients.
As experts in the healthcare sector, K Low Consulting can help you learn more about these important developments, develop your strategy, help you create winning tender bids and grow your business.
What is a virtual ward?
Virtual wards allow patients to get the care they need at home, safely and conveniently, freeing up hospital beds for patients who really need them.
Supervised by hospital and community-based clinicians, virtual wards allow conditions such as coronavirus to be dynamically monitored while the patient stays in the comfort of their own home. For example, coronavirus patients can be discharged safely to a virtual ward with an oximeter – a small, lightweight device which measures the amount of oxygen in their blood. Readings are taken regularly and fed into the patients health tracking system. The system is configured to identify outlier readings, flagging these to both the patient and the clinical team for closer monitoring and escalation where required (either via video call or face-to-face visit).
The approach is all part of the NHS@Home programme which is building on the lessons learned from the pandemic, to enable patients to access personalised healthcare at home, rather than having to make appointments with their GP or make lengthy journeys to their local hospital.
It’s a growing trend which isn’t going anywhere. By December 2023, The Nuffield Trust estimates that the NHS will have 40-50 virtual ward ‘beds’ per 100,000 people.
What do virtual wards mean for my business?
The move to virtual wards is opening up new opportunities for businesses to get involved in the healthcare sector, particularly those involved in the manufacture of monitoring equipment including oximeters and heart monitors and healthcare providers, including care homes, who can demonstrate a clear technology strategy.
Businesses who can provide data management systems, which ensure patients’ data is managed securely and legally, are also likely to be in high demand.
How can K Low Consulting help me to expand my business?
When it comes to tender bids within the healthcare sector, we can help you to open doors.
We’ve successfully created hundreds of bids for our clients, leading to £1 billion in healthcare contracts for NHS England, Clinical Commissioning Groups (CCGs) and the public health sector.
We work with all stakeholders to fully understand the challenges, using these insights to help our clients showcase their strengths and demonstrate how their business is best-placed to offer the best solutions.
If you would like more information or if would like to be made aware when relevant tender opportunities come up in your industry or field of expertise, contact us today on 0330 1331 041 or info@klowconsulting.com to see find out how we can help you.
In 2019, the NHS set out plans to revolutionise Integrated Care Systems (ICSs) as part of its Long Term Plan.
The proposals included:
Giving people more control over their own health and the care they receive
Encouraging more collaboration between GPs, their teams and community services, as ‘primary care networks’ to increase the services they can provide jointly
Increasing the focus on NHS organisations working with their local partners, such as Councils, as ‘Integrated Care Systems’, to plan and deliver services which meet the needs of their communities
Since the plan was first published in January 2019, health and social care are both areas that have been massively impacted by the COVID-19 pandemic, making the idea of a care system that is better integrated and gives patients more choice and control over their own healthcare sound almost impossible at this point in time.
The paper held the pandemic up as an example of what could be achieved if everyone in the health and care systems pulled together. It also recognised that there was a lot to be done to rebuild these decimated systems to not only get them back to where they were pre-pandemic, but to better than they have ever been.
How exactly will it work?
According to the February white paper, ‘instead of working independently, every part of the NHS, public health and social care system should continue to seek out ways to connect, communicate and collaborate so that the health and care needs of people are met’ and ‘health and care services, local government, NHS bodies, and others (will) work ever more closely together…with common purpose and in partnership’.
The Bill sets up a series of Integrated Care Systems to cover England. The ICSs will include an Integrated Care Board (ICB) which will assume the commissioning responsibilities currently undertaken by clinical commissioning groups. There will also be an Integrated Care Partnership (ICP), a secondary part of the system intended to give a voice to the wider health and care community.
Place level commissioning within an integrated care system will align geographically to a local authority boundary and the Better Care Fund (BCF) plan will provide a tool for agreeing priorities. This will be further supported by other measures including improvements in data sharing and enshrining a ‘triple aim’ for NHS organisations to support better health and wellbeing for everyone, better quality of health services for all, and sustainable use of NHS resources.
The future
The new legislative proposals in the paper that will be upheld by the Health and Care Bill ‘aim to build on the incredible collaborations we have seen through COVID’ and ‘shape a system that’s better able to serve people in a fast-changing world’.
The Bill also builds upon the original proposals made in the Long Term Plan and also looks at issues such as ‘removing transactional bureaucracy’ to make purchasing decisions easier, making better use of technology to support staff and patient care, and pledges to address staff shortages.
These are all potential opportunities from a tender or Framework point of view.
But, with a more ‘integrated’ system comes more partners and organisations. With the NHS, local authorities, the voluntary sector and others all working together to provide health and social care products and services in local areas, who will act as the Commissioner in a potential tender situation? If you are accepted onto one Framework, will you be eligible to join others?
One thing is for sure, tenders in health and social care are changing and we need to stay abreast of these changes.
Here are some suggested links for further reading:
For more information or to discuss how we can work with your organisation to help you win and manage health and social care contracts, contact us today on 0330 1331 041 or info@klowconsulting.com.
At the end of June, NHS England (NHSE) announced plans to transform the way integrated care systems (ICSs) buy non NHS goods and services in a document entitled NHS System Oversight Framework 2021/22.
But what is the significance of this framework? And what will it change for companies and organisations looking to land NHS contracts?
What is the NHS System Oversight Framework?
The NHS System Oversight Framework for 2021/22 replaces the NHS Oversight Framework for 2019/20, which brought together arrangements for provider and Clinical Commissioning Groups (CCGs) oversight in a single document.
This framework applies to all Integrated Care Systems (ICSs), Clinical Commissioning Groups (CCGs), NHS trusts and foundation trusts and focuses on five key metrics:
Quality of care
Access and outcomes
Preventing ill health and reducing inequalities
People; finance and use of resources
Leadership and capability
The approach to oversight is characterised by the following key principles:
a. working with and through ICSs, wherever possible, to tackle problems
b. a greater emphasis on system performance and quality of care outcomes, alongside the contributions of individual healthcare providers and commissioners to system goals
c. matching accountability for results with improvement support, as appropriate
d. greater autonomy for ICSs and NHS organisations with evidence of collective working and a track record of successful delivery of NHS priorities, including tackling inequality, health outcomes and access
e. compassionate leadership behaviours that underpin all oversight interactions
Implementation of the framework
While the scope of this framework reflects the role of NHS England and NHS Improvement as a national regulator of NHS provided and/or commissioned services, it also recognises that ‘the vision for ICSs is based on the core principles of equal partnership across health and local government: subsidiarity, collaboration and flexibility’ and that ‘delivering the priorities for the NHS depends on collaboration across health and care, both within a place and at scale’.
But implementing the framework won’t be easy and straight forward.
NHS leaders are looking for specificity in how oversight will operate within a system context and there will need to be a high degree of flexibility to design approaches that best reflect local circumstances and maintain ownership and engagement across the full range of system partners.
But implementing the framework won’t be easy and straight forward.
NHS leaders are looking for specificity in how oversight will operate within a system context and there will need to be a high degree of flexibility to design approaches that best reflect local circumstances and maintain ownership and engagement across the full range of system partners.
When will the framework be implemented?
The existing statutory roles and responsibilities of NHS England and NHS Improvement in relation to trusts and commissioners remain unchanged for 2021/22. The framework sets out how NHS leaders and organisations will be required to operate with their partners in ICSs from April 2022.
The oversight framework will be updated further for 2022/23. The updated document is expected to confirm ICSs’ formal role in oversight including:
bringing system partners together to identify risks, issues and support needs and facilitate collective action to tackle performance challenges
and
leading oversight and support of individual organisations and partnership arrangements within their systems.
What does it all mean going forward?
The thinking behind the framework is that local NHS procurement teams will be able to change the way they buy non-NHS goods and services and move towards a more system-level way of working, and away from procurement teams dedicated to single organisations.
ICSs will be able to “tailor their procurement organisation structure based on their respective level of maturity, spend profiles, associated phasing of roles and local considerations” but the lack of data harmonisation at local, regional and national level and clarity around best practice approach could make implementation difficult.
With regards to companies who are looking to supply the NHS at a local level, they will have to keep an eye on how this framework develops between now and April 2022 and establish relationships with the ICSs who will soon be in charge of their own procurement and spending.
If you are looking for help with securing NHS contracts, contact the K Low Consulting team on 0330 1331 041 or info@klowconsulting.com.
Restrictions brought in to control the Covid-19 virus have changed life as we know it. Not only has the pandemic dramatically impacted the way we live and work, but it has placed immeasurable strain on the NHS and medical services as frontline medical staff battle the greatest challenge they have faced in modern history.
New NHS England figures released this week show that in England in February 2021, around 4.7 million people were waiting for routine operations. These are the longest waiting lists since 2007.
Currently, almost 388,000 people have been waiting more than 12 months for non-urgent surgery. This figure was just 1,600 before the pandemic.
Many patients have held off seeking treatment for non-urgent medical complaints such as muscular injuries or unexplained aches and pains. Others have had routine treatment postponed or cancelled while the hospitals prioritise Coronavirus cases.
It is widely recognised that around 30 per cent of all GP appointments are musculoskeletal related problems. The demand for that treatment far outstrips the resource that is in place. In some areas, the waiting lists for a community musculoskeletal service appointment can be more than 6 months.
Unfortunately, with some injuries and ailments, while you are waiting to be seen, the problem could be getting worse.
Self-manage your own care from home
We, at K Low Consulting, are working alongside a brand-new, free to use, self-help website Online Physio Expert, which helps injured individuals to get the care and support they need.
If it is difficult for you to get an appointment with a doctor, or if you feel concerned about the risk of visiting a hospital during the pandemic, this new service allows you to access helpful advice and exercises put together by medical professionals, from the comfort of your own home.
We do a lot of work with health and social care providers and we are conscious that because of the pressures that the NHS were under pre-Covid, let alone post-Covid, that the access to physiotherapy treatment is limited.
If you are unable to reach a medical service, which has been the case for many during the pandemic, then Online Physio Expert is the next best thing – and you can access it free, and without a doctor referral.
How Online Physio Expert works
The easily navigated homepage gives numerous options for visitors to choose from. You can identify where your pain points lie and then go through a series of movement videos and tests in order to work out how to proceed.
From there you will be directed to a whole video library of more than 1200 high-definition videos with exercises, from levels 1 to 4, to help you with your specific problem. The level you are given will depend on the severity and type of injury you have sustained.
A clinician will talk you through how it should be done, the common mistakes to look out for and where you should be feeling the stretch.
A patient is able to try different levels and amend their exercise plan dependent upon their ability and movement restrictions. People can use the tool to screen themselves and manage their own care. Online Physio Expert offers a free, appropriate and immediate access solution.
This fantastic tool has already brought great relief and improvement to numerous patients, who have each been able to create an online account through the Online Physio Expert portal and access a customised treatment programme, based upon your capabilities and current condition.
Why wait? Access free online physio today!
Musculoskeletal injuries are often quite acute injuries and the longer that it takes to access the appropriate physio treatment, the less likely that any intervention will do any good.
The range of movement and strength you get back after an injury often depends on how quickly you access physiotherapy treatment. It can be lifechanging in terms of mobility. For many, seeing someone six months later will have no impact.
We are advocates of getting the treatment you need without putting yourself at any unnecessary further risk and this new website allows patients to do that.
Healthcare waiting lists in the UK are reported to be longer now than they have been for about two decades.
In total, 4.52 million people are currently on NHS waiting lists and around 224,000 patients have been waiting for longer than a year.
Experts have warned the overall waiting list figure could double to as much as 10 million by April.
The worrying statistics have prompted NHS Confederation chief executive Danny Mortimer to state that even once the impact of Covid-19 is understood, waiting lists are ‘still going to be significantly higher than we have seen for a very, very long time’.
His views have been echoed by Professor Neil Mortensen, the president of the Royal College of Surgeons, who has said there will need to be a ‘big plan’ to tackle the waiting list issue.
So, what might this plan look like? One solution could be ‘insourcing’, which we looked at in our December blog.
Reports have also begun to circulate about Government plans to shake-up NHS England in what could be the biggest health reform for a decade. The plans are set to reverse the changes made by the 2012 Health and Social Care Act which gave clinicians control over budgets and encouraged competition with the private sector.
When the 2012 Health and Social Care Act was introduced it did come in for some criticism. Politicians on the left disliked it because they saw the introduction of competitive tendering as a vehicle for private companies to undermine the NHS. Meanwhile, many on the right came to dislike it because of bureaucratic costs and confused lines of accountability.
New proposals
The new proposals would see central Government taking greater control of the NHS. Instead of a system that requires competitive tendering for contracts, the NHS and local authorities will be left to run services and told to collaborate with each other.
Although the plans say the pandemic had shown clearly that a broader approach to health and care is essential, critics have raised concern that the latest proposals are essentially rushing through the NHS Long Term Plan which includes plans to integrate health and social care into the Government. Others have questioned the sense of the Government launching these new plans whilst the NHS is still battling Covid-19 and is in the middle of the biggest vaccination programme in our history.
The worry is these changes will mean we move away from Clinical Commissioning Groups (CCG) which are GP-led, towards further nationalisation of the NHS. Questions are already being raised as to whether this is a power grab by ministers which won’t necessarily improve patient care.
The current 2012 Health and Social Care Act also means most contracts need to go out to tender and, as a result, the process is very transparent. We don’t yet have all the details of how things will work under the new proposals but you only need to look back on reporting of the Government’s handling of PPE procurements to see why it has to make sure any new system is transparent. In its rush to procure PPE during 2020 it was accused of handing out ‘jobs to pals’.
Hopefully, we will see some improvements under the new proposals. For example, it is more likely that smaller social contracts which really would have been better going to local trusts in recent years will go to those trusts by default under the new plans. Having said this, specialist contracts such as physiotherapy or dermatology services may still go out to tender as not every trust has a local provider of such specialisms.
As ever here at K Low Consulting we will be following such developments incredibly closely so that we can help our clients to be successful in their bid writing efforts.
Primary Care Networks are still in the early stages of formation and many people may be unaware or have little knowledge of them.
Primary Care Networks were introduced in the NHS Long Term Plan in 2019 and since then, there has been the beginning of many formations to collaborate healthcare services for the benefit of patients and their healthcare.
Since the introduction of the NHS’s Long Term Plan, practices have organised themselves into their Primary Care Networks as of 15th May 2019 and all except a handful of GP practices in England have come together, resulting in around 1,300 geographical networks (Kings Fund, 2019, https://www.kingsfund.org.uk/publications/primary-care-networks-explained).
Aiming to collaborate a workforce and form a more inclusive work environment to better the needs of patients, the particular challenges, risks and successes of these formed Primary Care Networks can be evaluated.
Questioning ‘are primary care networks a challenging collaboration?’, this article will provide a holistic overview of primary care networks, the potential risks and challenges and finally, the successes.
What are Primary Care Networks?
A Primary Care Network is one or more general practice’s working collaboratively together. This usually consists of networks of doctors and other healthcare providers such as dieticians, pharmacists and nurses.
As stated on the King’s Fund, networks are geographically based and cover all practice within a clinical commissioning group boundary.
It is not a requirement that primary care networks are formed, but if practices choose not to join, they will lose out on significant funding. It’s also important to note that occasionally, a single practice can function as a network if they meet the size requirements. PCN’s will receive funding to employ additional health professionals such as pharmacists and paramedics to enable a greater formation.
Why were Primary Care Networks introduced?
The NHS were facing issues with increased demand in healthcare services. Patients were living longer, with more complex and long-term health conditions. These issues were also coupled with an understaffed workforce.
As a result, the introduction of Primary Care Networks aimed to alleviate the strain on healthcare staff, allowing them to work together to deliver primary care services.
Primary Care Homes (introduced in 2015) were an approach to strengthening primary care. The model brings together a range of health and social care professionals to work together to provide enhanced personalised and preventative care for their local community.
Healthcare professionals were encouraged to work together, in networks of 30,000-50,00 patients, which built on the Primary Care Home model. Following this, in February 2018, refreshed ‘NHS Plans for 19’ was introduced. This plan set out the plans for CCG’s, encouraging every GP to be part of a PCN so that these could cover the whole country as far as possible by the end of 2018/2019.
As part of this contract, the DES announced that PCN’s must appoint a clinical director as their named leader, responsible for delivery. The network agreement states the rights and obligations of the GP practices within the network, how the network will partner with non-GP’s, and a patient data-sharing requirement.
Here are some key legislative dates as mentioned above:
2015: The National Association of Primary Care (NAPC) launched the Primary Care Home model at their annual conference April 2016: NHS England introduced GP Five Year Forward View 2nd February 2018: NHS England introduced ‘Refreshing NHS Plans for 19’ 7th January 2019: NHS Long Term Plan introduced 31st January 2019: GP Contract 2019/20 (outlines what PCN’s will be) 15th May 2019: Practices have to organise themselves into networks and submit signed network agreements to their clinical commissioning group (CCG). 1st July 2019: NHSE expects the network contract to provide 100% geographical coverage
Benefits of Primary Care Networks
As previously mentioned, PCN’s were introduced to allow GP and primary care services to scale up by grouping. As a PCN, workforces can team up to deliver as a larger entity and pull resource where needed.
PCN’s have the potential to substantially improve patient experience. One of the many benefits is that the accessibility of healthcare services increases, allowing them to have access to extended services.
In terms of other benefits, each PCN will encounter their own set of benefits individually. As provided below, success stories present two different sets of benefits for patients and staff.
Examples of these benefits as outlined in the success stories are:
Better work relationships and collaboration
A stronger focus on patient care and experience
Easier to identify key issues within the community through collaboration
As health.org.uk and Nuffield Health outlined, there are a particular set of risks and challenges associated with PCN’s:
1. Speed
One of the most prominent risks of PCN’s is the speed of implementation of these collaborations. With such a tight set of deadlines associated with PCN’s, it may be difficult for people to familiarise themselves with PCN’s and then form their practices into networks within these time restraints.
As Nuffield Health illustrated, these tight deadlines could mean that failure was inherent form the policy design. It could be said that these timescales are unrealistic and ambitious, not giving professionals enough time to adjust to the rapid changes.
2. Funding
In terms of deciding not to join a network, practices will miss out on the sources of funding. However, even if there is a formation of a PCN, there is a risk that there will be a removal of other sources of income for practices.
In addition to this, NHS England has promised to meet 70% of costs of employing most additional staff need for the PCN, meaning networks must cover the remaining 30% of the cost associated with this. This could be particularly costly for those practices that cannot afford this.
3. Workforce and workload
A particular risk associated with PCN’s is that they may decrease the amount of GP time available.
Additionally, there is no proof that the NHS is supplying 20,000 additional health professionals as stated in their plan. Increasing this workforce also means accommodating for these new staff members, which may pose a particular challenge for some GP’s where workspace is limited.
There could be a lack of operational support to realise the amount of PCN roles that need to be filled in this short time period. Additionally, some practices may not have the funding available to appoint new staff members.
4. Lack of collaboration
There is a risk that PCN’s may not be able to form effective organisations.
The knock-on effects of the lack of collaborations between practices are that there are disputes which could result in isolation and resist, creating further issues amongst networks. Thus, this could result in a lack of collaboration and the failure of an effective network model.
As stated on the King’s Fund website, the research found that collaboration in general practice was most successful when it had been generated organically over several years and if it was reinforced by trust, relationships and support. On the other hand, research has shown that a lack of clarity of purpose and engagement or over-optimistic expectations resulted in less effective collaborations. This suggests that collaboration and focus should be coupled together to form an effective PCN.
5. Lack of focus
There are a large number of objectives for PCN’s. The number of objectives that professionals must fulfil, may be unrealistic and put further pressure on them.
In 2020/21, there are five out of seven service specifications expected to be delivered. This heightened pressure on healthcare professionals may result in intolerable pressure resulting in a lack of focus.
Protecting Risks and Challenges of Primary Care Networks
Although, as Primary Care Networks are still in the early stages of development, these risks and challenges could be easily rectified at this early stage.
Nuffield Health provides a series of possible solutions to these problems, some of which are provided as examples below:
Issue: Lack of collaboration/ not able to create effective organisations
Possible Solutions:
Create a new vision for primary care: defining what an effective PCN looks like and what can be achieved.
Carve out time (using paid backfill, ideally from CCG’S/STP’s) to build a shared organisational vision
Draft vision statements as practical documents
Create clear roles for each of the different levels of the local system
Issue: Lack of focus
Possible Solutions:
‘Work with CCG’s and commissioning support units to undertake multi-level approaches to tackling population health and general operations’
‘share learning across practices and governance levels in a neighbourhood to create a sense of shared ownership’
Issue: Speed
Possible Solutions:
‘Policymakers should acknowledge that an organisational plan can take up to two years, and outcomes 5-10 years to realise’
‘STPS/ICSs and CCGs should work closely with PCNs to agree roles, responsibilities, development plans, timelines and funding arrangements until 2025’
‘PCNs leads and practice liaisons should jointly agree on the purpose of new roles and their contractual terms and conditions’
‘CCGs should examine where their management support should be best placed- this role has had little attention to date in primary care workforce planning and funding’
Issue: Workforce/ Workload
Possible Solutions:
‘create a shared physical space for the PCN and bring people together during their working day to talk about what they want to achieve’
‘help clinical directors to improve the capacity and capability of their network by focusing initially on small, achievable initiatives that help or reduce workload in individual practices and build trust’
‘Appoint leaders who have skills to make sense of the environment and set the direction, as well as managing the many different aspects of the organisation’s functions’
Successes of Primary Care Networks
Despite the foreseeable risks and challenges to PCN’s, there have been a number of success stories which illustrate the impact that they have already made.
They sought to identify the problems that their patients had and work towards rectifying these issues as a PCN. One of the issues identified was that they had a considerably high percentage of older patients and they had to be attentive when caring for those patients, especially those who were on a terminal decline. Thus, they appointed a care co-ordinator and benefitted from the PCN team across the network.
Alongside this, a Parkinson’s nurse was appointed, a partnership with the York Teaching Hospital has been formed and a rapid cancer diagnosis pathway is underway.
Dr Evans, one of the doctors in the Yorkshire Primary Care Network stated: “The care of our patients is a lot more organized and anticipatory, and [there is] less crisis. But actually, more important, it works”
There has been a substantial impact of this PCN, details of such are as followed:
‘They have been identified by an independent audit on behalf of NHS England as an exemplar of best practice’
‘They use a 0365 platform to share project information and documentation. This has provided visibility of project progress and support collaborative and agile working in the absence of shared file arrangements- dedicated programme support’
‘Dedicated programme support has enabled the work to move at pace, providing a structure for everyone to feed into and embrace’
‘CSU expertise within the programme management provided valuable support in sharing best practice across the network, using case studies to support current and future opportunities in collaborative working’
‘created a robust governance structure has enhanced working relationships and provided visibility and clarity on roles and responsibilities across the network’
Their shared vision is: “Working together to deliver high quality, innovative and sustainable healthcare for our community with commitment, compassion and integrity”.
Successes of Primary Care Networks: Self Evaluation for Staff
As exemplified by the National Association of Primary Care, Figure 2 presents the outcomes of a questionnaire for staff. It shows the self-assessment by PCN supervisors, of how networks have improved the workplace. As shown, there is a lower demand for primary health services and patients are engaging more and benefiting from healthier lifestyles.
Figure 5 (as presented on NAPC.co.uk) also presents that improved self-management, healthier lifestyles and patient engagement has increased pre vs. post PCN.
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